2.saliva

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Good afternoon

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CHAITANYA.PI MDSDept of Public Health Dentistry

PREVIOUS QUESTIONS ON SALIVA1. Discuss the role of saliva on dental health. (April,

October 2011).2. Write about various types of salivary glands. Describe

composition and functions of saliva (November, 2007).3. Parotid Gland (April, 2014).4. Discuss about the submandibular Gland and biological

role of saliva in oral health (August, 2013).5. Role of saliva in Dental Caries (May, 2008 and April,

2013).6. Describe the role of saliva in oral health (April, 2012).7. Role of saliva in oral health and disease (November,

2008).

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CONTENTSIntroductionSalivary gland anatomyFunctions of salivaSecretion of salivaComposition of salivaRole of Saliva in Dental Caries Hypofunction of salivary glands Saliva: A diagnostic tool Review of literature Conclusion References 4

WHAT IS SALIVA?Saliva is a component of oral fluid

The term saliva refers to the mixed fluid in the mouth in contact with the teeth and oral mucosa, which is often called ‘whole saliva’

saliva is produced in and secreted from the three pairs of major salivary glands and hundreds of minor salivary glands(600-1000)

Normally the daily production of whole saliva ranges from 0.5 to 1.0 litres

Ref : Essentials of physiology, K Sembulingam, pg.no.149-155, 1st edition, 2011.Ref : Orban’s Oral histology & Embryology, G S Kumar, pg.no. 292-312, 13th edition, 2013 5

90% of the whole saliva is produced by three paired major salivary glandso Parotid Gland o Submandibular glando Sublingual glandIn addition, whole saliva contains contributions from non-glandular sources such as gingival crevicular fluid in an amount that depends on the periodontal status of the patient


SALIVARY GLAND ANATOMY

PAROTID GLAND Largest of all the salivary glands

Purely serous gland that produce thin, watery amylase rich saliva

Superficial portion lies in front of external ear & deeper portion lies behind the ramus of mandible

Stensen's Duct (Parotid Papilla) Opens out adjacent to maxillary second molar

Ref : Human Anatomy head-neck-brain, B D Chaurasia’s, vol 3 pg.no.106-112, 6th edition, 2013. 7

SUBMANDIBULAR GLANDSecond largest salivary gland

Mixed gland

Located in the posterior part of floor of mouth, adjacent to medial aspect of mandible & wraps around the posterior border of mylohyoid muscle

Wharton's Duct Opens beneath the tongue at sub-lingual caruncle lateral to the lingual frenum


SUBLINGUAL GLANDSmallest salivary gland

Mixed gland but mucous secretory cells predominate

Located in anterior part of floor of mouth between the mucosa and mylohyoid muscle

Opens through series of small ducts (ducts of rivinus) opening along the sub-lingual fold & often through a larger duct(bartholin’s duct) that opens with the wharton’s duct at the sub-lingual caruncle


Ref : The Ciba Collection Of Medical Illustrations, Anatomy Of The Mouth, Frank H.Netter, 1959, Plate 12.10

Ref : Essentials of physiology, K Sembulingam, pg.no.149-155, 1st edition, 2011.

INNERVATION

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MINOR SALIVARY GLANDS

Labial and buccal glands

Glossopalatine glands

Palatine glands

Lingual glands


REGULATION OF SALIVA SECRETION

Afferent signals from sensory receptors of

mouth

Salivary nuclei in medulla

oblongata of brain

Parasympathetic & sympathetic nerve bundle

Trigeminal,glossopharyngeal , vagus

Salivary gland


THE SECRETATORY UNIT

The basic building block of all salivary glands

ACINI - water and ions derived from plasma

Saliva formed in acini flows down ducts to empty into the oral cavity

Ref : Orban’s Oral histology & Embryology, G S Kumar, pg.no. 292-301, 13th edition, 2013 14

SALIVONA salivon is the secretory unit of the

salivary gland

A salivon consists of acinus, intercalated duct & striated duct

Acinus secretes the basic materials of the saliva & as it passes through the intercalated and striated ducts undergoes modification and this final modified material is the saliva which appears in the oral cavity


Each salivary gland consists of a large number of acini

Acini responsible for producing primary secretion are

divided into three types,• Serous -spherical cells rich in zymogen

granules• Mucous-tubular shaped cells• Mixed- serous demilunes

Myoepithelial cells


The Parotid gland is a purely serous salivary gland. This gland is unique in that it contains many fatcells; in fact, the adipocyte to acinar cell ratio in the Parotid is 1:1

The Submandibular gland is mixed, but predominantly serous. Approximately 10% of its acini are mucinous

The Sublingual gland is mixed, but predominantly mucous


DUCTAL SYSTEMThe lumen of the acinus is continuous with the ductal system-composed of the,

Intercalated duct

Striated duct

Excretory ducts


SECRETION OF SALIVA


SALIVARY SECRETION-TWO STEP MODELFORMATION OF PRIMARY SALIVA Initiated by binding of neurotransmitters in the acinar

cell membranes Acinar cell loses K⁺ to the interstitium & Cl⁻ to the lumen Gain of Cl⁻ creates negative potential in the lumen,

driving interstitial Na⁺ into lumen thereby restoring electro neutrality Water flux follows the movement of salt into the lumen

for osmotic reasons, resulting in acinar cell shrinkage Outcome is the formation of isotonic primary saliva


At high flow rates, saliva is in contact with the ductal

epithelium for shorter time Na⁺ & Cl⁻ concentration & K⁺ concentration

At low flow rates, the electrolyte concentration change in the

opposite direction

The HCO₃⁻ concentration increases with increased flow

rates, reflecting the increased secretion of HCO₃⁻ by the acinar cells to drive fluid secretion


SALIVA PRODUCTION

DIFFERENTIAL SALIVA PRODUCTION BY GLANDS

Unstimulated salivation (Salivary gland at rest) • 1.5 Liters produced per day (basal rate) • Major salivary glands: 90% of saliva

produced • Submandibular and sublingual glands:

70% of saliva Stimulated salivation

• Saliva production increases 5 fold • Parotid gland produces majority of

saliva


FLOW RATE (ml/min)

WHOLE PAROTID SUBMANDIBULAR

RESTING 0.2-0.4 0.04 0.1

STIMULATED 2.0-5.0 1.0-2.0 0.8

pH 6.7-7.4 6.0-7.8



20-39 yr 40-59 yr > 60 yr0.00.10.20.30.40.5

Flow Rate of Saliva

unstimulated

stimulatedAge

ml /

min

MULTIFUNCTIONALITY

Anti-Bacterial

Buffering

Anti-ViralSALIVARY FUNCTIONS

Anti-Fungal

Digestion

Mineralization

Tissue coating

Lubrication &viscoelasticity

Amylases, Cystatins,Histatins, Mucins,Peroxidases,Ig A,Cystatins,Mucins

Histatins

Amylases,Cystatins, Mucins, Proline-rich proteins, Statherins

Cystatins,Histatins, Proline-rich proteins,Statherins

Mucins, Statherins

Carbonic anhydrases,Histatins

Amylases,Mucins, Lipase

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COMPOSITION OF SALIVA

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Ref : Essentials of physiology, K Sembulingam, pg.no.149-155, 1st edition, 2011. 27

INORGANIC COMPONENTS

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Help to prevent dissolution of dental enamel Calcium

1.4 mmol/lt. (1.7 mmol/lt. in stimulated saliva)50% in ionic formsublingual > submandibular > parotid

Phosphate • 6 mmol/lt. (4 mmol/lt. in stimulated saliva)• 90% in ionic form

pH around 6 - hydroxyapatite is unlikely to dissolve Increase of pH - precipitation of calcium salts

dental calculus

CALCIUM AND PHOSPHATE

Ref : Essentials of physiology, K Sembulingam, pg.no.149-155, 1st edition, 2011.Ref : Orban’s Oral histology & Embryology, G S Kumar, pg.no. 292-312, 13th edition, 2013.Ref : Carranza’s Clinical Periodontology, Newman, pg.no.331-338, 11th edition, 2012. 29

HYDROGEN BICARBONATE Buffer

Low in unstimulated saliva, increases with flow rate

Pushes pH of stimulated saliva up to 8

pH 5.6 critical for dissolution of enamel

Defence against acids produced by cariogenic bacteria

Derived actively from CO2 by carbonic anhydraseRef : Essentials of physiology, K Sembulingam, pg.no.149-155, 1st edition, 2011.Ref : Orban’s Oral histology & Embryology, G S Kumar, pg.no. 292-312, 13th edition, 2013.Ref : Carranza’s Clinical Periodontology, Newman, pg.no.331-338, 11th edition, 2012. 30

OTHER IONS

Fluoride • Low concentration, similar to plasma Thiocyanate• Antibacterial (oxidated to hypothiocyanite OSCN- by

active oxygen produced from bacterial peroxides by lactoperoxidase)

• Higher conc. => lower incidence of caries• Smokers - increased concentration Sodium, potassium, chloride Lead, cadmium, copper• May reflect systemic concentrations - diagnostics


ORGANIC COMPONENTS

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Saliva contains immunologic & non immunologic agents for the protection of the teeth & mucosal surfaces

Immunologic contents-secretory IgA, IgG & IgM

Non immunologic contents-proteins, mucins, peptides & enzymes(lactoferrin, lysozyme, peroxidase)

Coagulation factors – factor VIII, IX, X, plasma thromboplastin antecedent, hegman factor- hastens blood coagulation & protects wound from bacterial invasion

ANTI – BACTERIAL FACTORS


SIgA - main specific immune defense mechanism in saliva and may be important in maintaining homeostasis in the oral cavity

IgA antibodies present in parotid saliva can inhibit the attachment of oral streptococcus species to epithelial cells

Many bacteria in saliva have been shown to be coated with IgA and bacterial deposits on teeth contain both IgG and IgA in quantities greater than 1% of their dry weight

IMMUNOGLOBULINS -A


LEUKOCYTES

In addition to desquamated epithelial cells saliva contains all forms of leucocytes, of which principal cells are PMNs

PMNs reach the oral cavity by migrating through the lining of the gingival sulcus

Lining PMNs in saliva are sometimes refered to as orogranulocytes and their rate of migration into the oral cavity is termed as OROGRANULOCYTIC MIGRATORY RATE


MUCINS Products of acinar cells from submandibular, sublingual and

some minor salivary glands

Asymmetrical molecule with open, randomly organized structure

Glycoproteins - protein core with many oligosaccharide side chains attached by glycosidic bond

Hydrophillic

Unique rheological properties (e.g., high elasticity, adhesiveness, and low solubility)


Major salivary mucins are

MG1-adsorbs tightly to the tooth surface contributing to the enamel pellicle formation, thereby protecting the tooth surface from chemical & physical attack including acidic challenges

MG2- also binds to the tooth surface but is easily displaced, however it promotes clearance of oral bacteria by aggregation


MUCINS FUNCTION

Tissue Coating• Protective coating about hard and soft tissues• Primary role in formation of acquired pellicle• Concentrates anti-microbial molecules at

mucosal interface Lubrication

• Align themselves with direction of flow (characteristic of asymmetric molecules)

• Increases lubricating qualities (film strength)• Film strength determines how effectively

opposed moving surfaces are kept apartRef : Essentials of physiology, K Sembulingam, pg.no.149-155, 1st edition, 2011.Ref : Orban’s Oral histology & Embryology, G S Kumar, pg.no. 292-312, 13th edition, 2013. 38

Aggregation of bacterial cells• Bacteria adhere to mucins-result in surface

attachment, or• Mucin-coated bacteria may be unable to

attach to surface Bacterial adhesion

• Mucin oligosaccharides mimic those on mucosal cell surface

• React with bacterial adhesins, thereby blocking them

Ref : Essentials of physiology, K Sembulingam, pg.no.149-155, 1st edition, 2011.Ref : Orban’s Oral histology & Embryology, G S Kumar, pg.no. 292-312, 13th edition, 2013. 39

AMYLASES Produced by acinar cells of major salivary glands Metabolizes starch and other polysaccharides into

glucose & maltose Calcium metalloenzyme Parotid; 30% of total protein in parotid saliva “Appears” to have digestive function - inactivated

in stomach, provides disaccharides for acid-producing bacteria

It is also present in tears, serum, bronchial, and male and female urogenital secretions

A role in modulating bacterial adherence


LINGUAL LIPASE Secreted by sublingual gland and parotid gland

Involved in first phase of fat digestion

Hydrolyzes medium to long chain triglycerides

Important in digestion of milk fat in newborn

Unlike other mammalian lipases, it is highly hydrophobic and readily enters fat globules


STATHERINS

Produced by acinar cells in salivary glands

Inhibits spontaneous precipitation of calcium phosphate salts from supersaturated saliva & favors remineralization

Also an effective lubricant for the tooth surface thus protecting it from physical forces


PROLINE-RICH PROTEINS (PRPS)

Like statherin, PRPs are also highly asymmetrical Present in the initially formed enamel pellicle and in

“mature” pellicles 2 types:• Basic• Acidic Both are secretory products of major salivary glands Acidic proline-rich protein binds tightly to

hydroxyapatite and prevents precipitation of calcium phosphate and thereby protecting the enamel surface & preventing demineralization

Also bind to oral bacteria including mutans streptococcci


ROLE OF PRPS IN ENAMEL PELLICLE FORMATION Acquired enamel pellicle is 0.1-1.0 µm thick layer of

macromolecular material on the dental mineral surface

Pellicle is formed by selective adsorption of hydroxyapatite-reactive salivary proteins, serum proteins and microbial products such as glucans and glucosyl-transferase

Pellicle acts as a diffusion barrier, slowing both attacks by bacterial acids and loss of dissolved calcium and phosphate ions


REMINERALIZATION OF ENAMEL AND CALCIUM PHOSPHATE INHIBITORS

Early caries are repaired despite presence of mineralization inhibitors in saliva

Sound surface layer of early carious lesion forms impermeable barrier to diffusion of high mol.wt. inhibitors

Still permeable to calcium and phosphate ions

Inhibitors may encourage mineralization by preventing crystal growth on the surface of lesion by keeping pores open


CALCULUS FORMATION AND CALCIUM PHOSPHATE INHIBITORS Calculus forms in plaque despite inhibitory

action of statherin and PRPs in saliva

May be due to failure to diffuse into calcifying plaque

Proteolytic enzymes of oral bacteria or lysed leukocytes may destroy inhibitory proteins

Plaque bacteria may produce their own inhibitors


INTERACTION OF ORAL BACTERIA WITH PRPS AND OTHER PELLICLE PROTEINS

Several salivary proteins appear to be involved in preventing or promoting bacterial adhesion to oral soft and hard tissues

PRPs are strong promoters of bacterial adhesion• Amino terminal: control calcium phosphate ions

• Carboxy terminal: interaction with oral bacteria

Interactions are highly specificRef : Carranza’s Clinical Periodontology, Newman, pg.no.331-338, 11th edition, 2012.Ref : Orban’s Oral histology & Embryology, G S Kumar, pg.no. 292-312, 13th edition, 2013. 47

LACTOFERRIN

Iron-binding protein

Prevents iron from being used by microorganism that require it for metabolism

Nutritional immunity (iron starvation)

Some microorganisms (e.g., E. coli) have adapted to this mechanism by producing enterochelins.

• bind iron more effectively than lactoferrin• iron-rich enterochelins are then reabsorbed by bacteria

Lactoferrin, with or without iron, can be degraded by some bacterial proteases.

Ref : Carranza’s Clinical Periodontology, Newman, pg.no.331-338, 11th edition, 2012.Ref : Orban’s Oral histology & Embryology, G S Kumar, pg.no. 292-312, 13th edition, 2013. 48

LYSOZYME

Positively charged enzymatic protein which binds to salivary anions of various types (bicarbonate, fluoride, iodide, nitrate) and forms a complex which binds to cell wall of bacteria & destabilizes the cell wall

Present in numerous organs and most body fluids

Also called muramidase

Alters glucose metabolism in sensitive bacteria

Causes aggregation,contributing to clearance of bacteria from the oral cavityRef : Carranza’s Clinical Periodontology, Newman, pg.no.331-338, 11th edition, 2012.Ref : Orban’s Oral histology & Embryology, G S Kumar, pg.no. 292-312, 13th edition, 2013. 49

HISTATINS

A group of histidine-rich proteins

The major form in the oral cavity are histatin 1,histatin 3 and histatin 5

Binds to hydroxyapatite and prevent calcium phosphate precipitation from a supersaturated saliva and favor remineralization

Potent inhibitors of Candida albicans growth


CYSTATINS

Are inhibitors of cysteine-proteases Are present in many body fluids Prevent the action of potentially harmful

proteases on the soft tissue of oral cavity Considered to be protective against unwanted

proteolysis• bacterial proteases• lysed leukocytes

Also inhibits calcium phosphate precipitation Promotes supersaturation of saliva with calcium

and phosphate, thus protecting the tooth surface


SALIVARY PEROXIDASE SYSTEMS Sialoperoxidase (SP, salivary

peroxidase) Produced in acinar cells of parotid

glands• Also present in submandibular saliva

• Readily adsorbed to various surfaces of mouth

Myeloperoxidase (MP)• From leukocytes entering via gingival crevice

• 15-20% of total peroxidase in whole salivaRef : Carranza’s Clinical Periodontology, Newman, pg.no.331-338, 11th edition, 2012.Ref : Orban’s Oral histology & Embryology, G S Kumar, pg.no. 292-312, 13th edition, 2013. 52

ROLE OF SALIVA IN DENTAL CARIES

53Ref : Understanding dental caries, G. Nikiforeck, vol.1, pg.no.237-238,1985

1. COMPOSITION: -

• Many inorganic and organic components of saliva have been investigated for anti cariogenic effects.

• In normal circumstances, saliva is supersaturated with calcium and phosphate ions With respect to enamel hydroxyapatite.

• This not only prevents enamel from dissolving but even tends to precipitate apatite in the surface enamel of carious lesions.

2. pH OF SALIVA: -• The “critical” pH at which the inorganic material of tooth begins to dissolve is about 5.5,

since above this pH, saliva is supersaturated with Ca and Po4 ions.

• Although much has been discussed about buffering capacity of saliva, its relation with caries incidence is not so simple!

• Acid production during caries occurs at a localized site on tooth, which in initial stages at least, is covered by dental plaque. This plaque prevents a free exchange of ions.

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3. QUANTITY OF SALIVA: -• Caries incidence is significantly higher in people with less or no saliva flow, as is

seen in cases of salivary gland aplasia and xerostomia.

• Continuous flow of saliva is required for mechanical removal of bacteria and food debris from the tooth surfaces.

4. VISCOSITY OF SALIVA: -• Viscous saliva is associated with high caries incidence as some studies have

reported.

• The reverse has also been shown to be true in some other studies.

5. ANTIBACTERIAL PROPERTIES: -• Saliva contains many antibacterial factors like lysozyme, lactoferrin,

sialoperoxidase, bistatin, thiocyanate ion, IgA etc.

• However their efficacy has been doubtful as saliva always appears to contain bacteria capable of causing caries if carbohydrates are present.

Ref : Understanding dental caries, G. Nikiforeck, vol.1, pg.no.237-238,1985

HYPOFUNCTION OF SALIVARY GLAND

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XEROSTOMIA

It is a clinical manifestation of salivary gland dysfunction and it does not represent a disease entity More prevalent in women Can cause significant morbidity and a reduction

in a patient’s perception of quality of life When unstimulated salivary flow is less than

0.12 to 0.16 ml/minute, a diagnosis of hypofunction is established

Ref : Neville, Oral and maxilla facial pathology, pg.no.455-498, 3rd edition,2009.Ref : Essentials of physiology, K Sembulingam, pg.no.153-155, 1st edition, 2011. 56

ETIOLOGY AgingFoods: alcohol, coffee, smokeDrugs:• Anti-depressants• Anti-histamine

• Cimitidine• Anti-cholinergic• Anti-inflammatory

Systemic factors• Emotions: nervousness , excitation, depression, stress.. • Encephalitis, brain tumors, stroke, Parkinson’s disease• Dehydration: diarrhea, vomiting, polyuria of diabetes …• Anemia, nutrition deficiency.


Radiotherapy• Acini atrophy fibrosis or replaced by fatty tissue• Serous acini: more sensitive to R/T• Saliva: thickened, altered electrolytes, pH↓,• secretion of immunoglobulins↓• >1000rad (2-3wk): felt oral dryness• >4000rad: irreversible changeSjogren’s syndromeOther salivary gland diseases


SYMPTOMS • Oral dryness (most

common)• Halitosis• Burning sensation • Loss of sense of taste or

bizarre taste• Difficulty in swallowing • Tongue tends to stick to

the palate • Decreased retention of

denture

• Saliva pool disappear• Mucosa: dry or glossy• Duct orifices: viscous

and opaque saliva• Tongue:• glossitis fissured

red with papilla atrophy• Angular cheilitis• Rampant caries: cervical

or cusp tip• Periodontitis• Candidiasis

SIGNS


CLINICAL APPEARANCE:• Oral mucosa appears dry, pale, or atrophic• Tongue may be devoid of papillae with fissured

and inflamed appearance• New and recurrent dental caries• Difficulty with chewing, swallowing, and

tasting may occur• Fungal infections are common


• Pale Fisured Tongue Due To Severe Dry Mouth

Ref : Neville, Oral and maxilla facial pathology, pg.no.455-498, 3rd edition,2009 61

Moderate Xerostomia


Severe Dry Mouth (Strawberry Tongue)


DIAGNOSIS

History takingSymptoms & clinical examinationSpecial investigations• Salivary flow rate(SFR)• Salivary scintiscanning• Sialochemical analysis & laboratory values • Labial biopsy• Sialography


Dietary:• Avoid drugs that may produce xerostomia

• Avoid dry & bulky foods

• High fluid intake & rinsing with water

• Avoid alcohol, smoking and sugar

• Take protein and vitamin supplements

Environment:• Maintain optimal air humidity in the home

• Use Vaseline to protect the lips

MANAGEMENT


Saliva Substitutes:

• Sodium carboxymethyl cellulose:0.5% aqueous solution

• Commercial oral moisturizing gels includes:

• OralBalance• XERO-Lube• Salivart• Optimoist


Saliva Stimulants:The use of sugar free gum, lemon drops or mints are conservative methods to temporarily stimulate salivary flow in patients with medication of xerostomia or with salivary gland dysfunction

• Biotine chewing gum

• Pilocarpine HCl May need 2-3 months to determine effectiveness Side effects include sweating and diarrhea Avoid in patients with narrow angle glaucoma, severe asthma, pulmonary diseases


PTYALISM

Difficulty in handling normally produced saliva Due to alteration in mouth anatomy or because of

impaired neurologic control of swallowing reflex Parkinson’s disease, Amyotrophic lateral

sclerosis, Cerebral vascular accidents ,Dementia & Developmental disorders

Underlying cause is untreatable-Anticholinergic agents offer some help in decreasing the salivary flow


BURNING MOUTH SYNDROME

Burning mouth syndrome (BMS) is a painful, frustrating condition often described as a scalding sensation in the tongue, lips, palate, or throughout the mouthSigns & Symptoms• Tingling or numbness on the tip of the

tongue or in the mouth • Bitter or metallic changes in taste • Dry or sore mouth.


CAUSES Damage to nerves that control pain and taste Hormonal changes Dry mouth, which can be caused by many medicines

and disorders such as Sjögren’s syndrome or diabetes Nutritional deficiencies Oral candidiasis, a fungal infection in the mouth Acid reflux Poorly-fitting dentures or allergies to denture

materials Anxiety and depression.


DIAGNOSIS Medical history

Blood examination to look for infection, nutritional deficiencies, and disorders associated with diabetes or thyroid problems

Oral swab to check for oral candidiasis

Allergy testing for denture materials, certain foods, or other substances that may be causing symptoms


MANAGEMENT Adjusting or replacing irritating dentures Treating existing disorders such as diabetes, Sjögren’s

syndrome, or a thyroid problem to improve burning mouth symptoms

Recommending supplements for nutritional deficiencies Switching medicine, where possible, if a drug you are

taking is causing your burning mouth Prescribing medications to • relieve dry mouth • treat oral candidiasis • help control pain from nerve damage • relieve anxiety and depression.


SALIVA AS DIAGNOSTIC TOOL Presence of s.mutans ,lactobacilllus spp & lactic acid – subsurface demineralisation & onset of carious lesion

Candida spp-candiasis

Cystic fibrosis- Nacl, CaPo4, lipid & proteins

21 hydroxylase deficiency – a strong correlation between 17- hydroxyprogestrone levels in saliva

Sjogrens syndrome- CD4 lympocytes, IgG ,Ig A,NaCl, lactoferin,albumin

microglobulin , cystanin c & s , PGE2, TXA2Ref : Neville, Oral and maxilla facial pathology, pg.no.455-498, 3rd edition,2009.Ref : Carranza’s Clinical Periodontology, Newman, pg.no.331-338, 11th edition, 2012. 73

Squamous cell carcinoma – Protein P 53 antibody

Breast cancer- c-erb B-2 tumor marker

Ovarian cancer- CA 125 tumor marker

Hepatitis – hepatitis a & b antigen

Saliva is used to detect antibodies against rubella, parotitis, rubeola viruses

Neonates – presence of IgG is marker of rota virus infection

HIV- IgA level orasure system - detects Ig G antibody against anti-HIV immunoglobulin

Thiocynate – indicator of active or passive smoking

Ref : Neville, Oral and maxilla facial pathology, pg.no.455-498, 3rd edition,2009.Ref : Carranza’s Clinical Periodontology, Newman, pg.no.331-338, 11th edition, 2012. 74

POSSIBLE SALIVARY MARKERS FOR PERIODONTAL DIAGNOSIS

Enzymes – Alkaline phosphatase, β-galactosidase, β-glucosidase, β-

glucuronidase, Collagenase, Esterase, Gelatinase, Lysozyme, Peroxidase, Trypsin

Immunoglobulins – IgA, IgG, IgM

Proteins - Cystatins, Fibronectin , Lactoferrin, Epidermal growth factor,

Platelet activating factor, Vascular endothelial growth factor, Histatin

Phenotypic markers - Epithelial keratins

Ref : Neville, Oral and maxilla facial pathology, pg.no.455-498, 3rd edition,2009.Ref : Carranza’s Clinical Periodontology, Newman, pg.no.331-338, 11th edition, 2012. 75

REVIEW OF LITERATUREMiri Cohen et al (2014) conducted a study To assess the associations between the cognitive and emotional dimensions of exam stress and pH levels, and the predictability of salivary pH in relation to test performance on Eighty-three nursing students, a questionnaire on stress appraisals, experienced stress, test anxiety (including worry and emotionality subscales) and health behaviours, and gave a saliva sample for measuring pH on the morning of their first term exam and three months later. Their performance on the test (grades) was also recorded. Levels of pH in saliva were higher (levels of acidity were lower) in the post exam compared to the exam period, in parallel to lower threat appraisal, experienced stress, and test anxiety levels post exam. Controlling for smoking, physical activity and working hours per week, pH levels at both time points were predicted by appraised threat regarding the exam situation, experienced stress, and the emotionality dimension of test anxiety. pH at Time 1 predicted performance on the exams and mediated the associations of experienced stress and emotionality subscale with test performance. The study indicates that pH levels may serve as a reliable, accessible and inexpensive means by which to assess the degree of physiological reactions to exams and other naturalistic stressors.

Ref: Miri Cohen et al, Saliva pH as a biomarker of exam stress and a predictor of exam performance, Journal of Psychosomatic Research, Volume 77, Issue 5, November 2014, Pages 420–425

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Ref: Jingyi Liu et al, Saliva: A potential media for disease diagnostics and monitoring, Oral Oncology, 48, 2012, pg.no. 569–577.

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Jingyi Liu et al (2012) conducted study on Saliva: A potential media for disease diagnostics and monitoring, the use of saliva as a diagnostic tool has gained considerable attention and become a well-accepted method. As a diagnostic fluid, saliva offers superiority over serum due to both a non invasive collection method by specially trained persons and a cost-effective approach for screening of large populations. Collection of saliva offers a reduced risk of infection compared to the collection of serum. Moreover, obtaining saliva samples from infant, disabled or anxious patients, is much easier than obtaining other samples. There are a lot of useful components-changing information in saliva when a person is in sick. Therefore, they define these changing components as ‘‘biomarkers’’. The utilization of biomarkers as early predictors for clinical disease not only contributes to the effective prevention and treatment of diseases, but also enhances the assessment of potential health risks. The salivary analysis method for biomarker discovery, and the diagnostic potentials of salivary biomarkers in monitoring and detecting periodontal disease, Oral and Breast cancers, and Sjögren’s syndrome. Saliva is indeed an effective media in various disease monitoring and diagnosis.

Saliva lacks the drama of blood, the emotion of tears and toil of sweat but it still remains one of the most important fluids in the human body

Conclusion

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REFERENCES

1. K Sembulingam Essentials of physiology, 2011, pg.no.149-155, 1 st edition.

2. Neville, Oral and maxilla facial pathology, 2009, pg.no.455-498, 3 rd edition.

3. Newman, Carranza’s Clinical Periodontology, 2012, pg.no.331-338, 11 th edition.

4. Human Anatomy head-neck-brain, B D Chaurasia’s, vol 3 pg.no.106-112 & 131-139, 6th edition, 2013.

5. The Ciba Collection Of Medical Illustrations, Anatomy Of The Mouth, Frank H.Netter, 1959, Plate 12.

6. G S Kumar, Orban’s Oral histology & Embryology, 2013, pg.no. 292-312, 13 th edition.

7. Understanding dental caries, G.Nikiforeck, vol.1, pg.no.237-238,1985

8. Miri Cohen et al, Saliva pH as a biomarker of exam stress and a predictor of exam performance, Journal of Psychosomatic Research, Volume 77, Issue 5, November 2014, Pg.no: 420–425.

9. Jingyi Liu et al, Saliva: A potential media for disease diagnostics and monitoring, Oral Oncology, 48, 2012, pg.no. 569–577.

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Thank you

2.saliva

Health & Medicine